Dental Insurance

Dental Insurance: How it Works

How it Works

Dental insurance works similarly to individual health insurance plans.

  • There are managed care options to choose from: HMO, PPO, and EPO.
  • Each plan requires monthly premium payments per individual covered.
  • Plans may have co-pays, coinsurance, and annual maximum benefit (between $500 to $1,200).
  • Coverage will vary depending on whether the procedures are considered preventative, basic, or major services.
  • Dental insurance does NOT cover cosmetic dentistry.

Dental Insurance: Dental Services

Dental Services

Dental procedures generally fall into one of three categories: preventative, basic, and major services.

Preventive

  • examinations
  • cleanings (prophylaxis)

  • bitewing x-rays

  • periapical x-rays

  • full-mouth, panorex x-rays

  • fluoride treatments

Basic Restorative Services

In general, basic services are typically those types of treatments and procedures that are relatively straightforward in nature and don't involve a significant laboratory expense for the dentist.

  • emergency care for pain relief
  • amalgam fillings

  • composite fillings (white fillings)

  • sedative fillings

  • routine tooth extractions

  • root canal treatment

  • periodontal scaling and root planing

  • periodontal surgery (may be Major service)

  • recementing dental crowns

  • stainless steel (prefabricated) crowns

 Major Restorative Services

Major dental services typically includes procedures and treatments that are relatively more complex in nature and often involve a dental laboratory expense. These services tend to be more costly than those found in the Basic category.

  • ​crowns (may be a Basic service)
  • inlays and onlays

  • bridgework

  • tooth implants

  • impacted wisdom teeth removal (may be Basic)

  • complex oral surgery procedures

  • removable partial dentures

  • complete dentures

  • denture relines and rebases

  • denture repair

  • orthodontic treatment

 

Things to Watch Out For:

Every dental plan is different. These are to be used as reference only. Note how some procedures can fall into either Basic or Major Restorative Services category, depending on the dental plan or complexity of the procedure.

Dental Insurance: How Does it Compare?

Dental Discount Plan: How Does it Compare?

Dental discount plans are not dental insurance.

  • There is a network of dental providers to choose from.
  • Under our discount plans, family members can be on the same plan and is part of a bundled subscription service.
  • There are no deductible, copays, coinsurance, waiting periods, annual maximums, or waiting period.
  • Cost of dental discount plans are comparable, usually lower, than dental HMO plans.
  • Select dental savings plan cover cosmetic dentistry. The Dentemax discount plan DOES cover cosmetic dentistry.

Why is the discount better?

  • No waiting periods

  • No deductibles
  • No age restrictions
  • No claim forms
  • No restrictions on services
  • No annual maximums
  • No copays

Dental Insurance: Bringing It Together

What we offer our customers is a dental discount plan. It is essential that we understand the difference and can explain it to our customers. 

Bringing It Together

Customer requires dental implants to be performed. The estimated cost of the procedure is $4,000. What can the customer expect from a dental insurance plan vs. dental discount plan?

 

Under the common dental plan, with a $1,000 Maximum Annual Benefit

  • The customer must go to in-network provider.
  • Since dental implants are considered major restorative services, the customer will have to make continuous monthly premium payments for 12 months before the insurance will provide coverage.
  • Under this example plan, the coverage for major restorative services is only 50%, so coverage would be $2,000, BUT
  • The maximum annual benefit is $1,000. So long as the customer has not already used their insurance earlier in the year for any other dental procedures, the insurance will cover $1,000 of the dental implant procedure.
  • Typically, the dental office will file the dental claim to the insurance company.
  • Coverage by dental insurance plan: $1,000. Remaining out of pocket: $3,000.

 

Under the Discount Plan

  • Customer must go to in-network provider.

  • Since there is no waiting period, customer can schedule an appointment with dental provider as soon as they're ready to go in for services.

  • There are no claims to process.
  • The customer must make payment upfront to the dental office or set up monthly payments.
  • Based on the fee schedule, estimated discount for the procedures is about 33% off.
  • Coverage by dental discount plan: $1,320. Remaining out of pocket: $$2,680.


Although the out of pocket cost for the customer is only a few hundred dollars extra in savings, keep in mind that the customer:

  • Did not have to wait 12 months for services.
  • Did not have to pay a year's worth of premiums before being able to get partial coverage
  • Didn't have to play the wait game with the insurance company, wondering if their claim would be approved
  • THE CUSTOMER SAVED MONEY

 

 

Things to Remember:

  • Dental discount plans are not insurance. This needs to stated every time before we go into an explanation of what it is with a customer.
  • Dental discount plans are not for everyone, but if we can educate the customer on how dental insurance and dental discount plans work, they can be better informed in shopping dental insurance plans and can see the value of dental discount plans. 
  • Customer education is the key to sales and retention.
  • If customer is still not happy with dental discount plan, refer to our GoHealth's Member Services teams to discuss dental insurance options.
  • Let the customer know that the dental discount plan is just one portion of our bundled services, which also includes the Concierge Service, Rx Optimization, Telemedicine, and other discounts.